Organization
OPTUMCARE FLORIDA, LLC
Active
Parent organization
MEDVANTX, INC.
Other names
JSA Medical Group Sun City Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
JOHN G. LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
733 CORTARO DR, RUSKIN, FL 33573-6812
(813) 634-2500
Mailing address
10051 5TH STREET NORTH, ST. PETERSBURG, FL 33702-2299
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
ME83064
FL
Other
Enumeration date
01/04/2013
Last updated
08/19/2019
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